烧伤后增生性瘢痕压力治疗及相关研究
소상후증생성반흔압력치료급상관연구
Pressure therapy of hypertrophic scar after burns and related research
  • 万方数据
    中华烧伤杂志 중화소상잡지
    16
    2010年 6期 411-415 ,共5页

    李曾慧平%冯蓓蓓%李奎成

    리증혜평%풍배배%리규성

    烧伤%瘢痕%组织学%压力治疗%智能压力衣 燒傷%瘢痕%組織學%壓力治療%智能壓力衣
    소상%반흔%조직학%압력치료%지능압력의
    Burns%Cicatrix%Histology%Pressure therapy%Smart pressure monitored suit
    目的 初步研究压力治疗的作用机制,探讨有效的压力治疗措施.方法 设计多组试验,分别探讨压力治疗的疗效与作用机制、智能压力衣的研制及应用效果.(1)压力治疗的疗效研究.将45例四肢烧伤患者按照随机数字表法分为压力治疗组36例和对照组9例,压力治疗组每日超过23 h穿着量身定做的压力衣(压力为10%缩率+局部9 mm厚压力垫),对照组不进行针对瘢痕的任何治疗.采用温哥华瘢痕量表(VSS)、颜色光学测试仪和软组织触诊超声系统评定瘢痕情况,对数据进行独立样本t检验或配对t检验.(2)了解Fb在压力作用下生长速率的变化.从手术切取的瘢痕组织中提取Fb,分别施加1.1、2.8、5.6 mm Hg(1 mm Hg=0.133 kPa)压力及不施加压力,观察Fb的生长速率(数据进行Fisher LSD post-hoc分析).(3)压力作用下瘢痕厚度的研究.应用高频超声成像系统,评估不同时期(早期:1～6个月,中期:7～12个月,后期:大于12个月)增生性瘢痕组织在0、5、15、25、35 mm Hg压力作用下的厚度变化(数据进行相关性及回归分析).(4)智能压力衣的应用研究.嘱曾经接受过传统压力衣治疗的36例患者穿着智能压力衣1个月,应用Pliance X系统进行压力测定并发放问卷调查患者使用情况,数据行Wilcoxon Sign-Ranks检验.结果 (1)治疗2个月压力治疗组瘢痕厚度、颜色及VSS评分均较治疗前明显改善;与对照组相比,治疗2个月压力治疗组VSS评分明显降低.(2)加压2 d,施加压力为5.6 mm Hg的Fb生长速率明显低于未施加压力者(均差=0.086、P=0.001);加压3 d,施加压力为2.8、5.6 mm Hg的Fb生长速率明显低于未施加压力者(均差分别为0.060、0.118,P值分别为0.003、小于0.001).(3)增生性瘢痕组织的厚度在压力作用下明显变薄,且厚度与压力大小呈负相关(r=-0.96,P＜0.01).(4)使用智能压力衣1个月后,静态压力减少19.5%、动态压力减少11.9%,明显低于传统压力衣压力减少量(约为50.0%).问卷调查结果显示,智能压力衣在舒适性、透气性、疗效等方面均明显优于传统压力衣(P值均小于或等于0.001).结论 初步证明压力治疗能有效抑制增生性瘢痕生长,但其确切机制仍需进一步研究证实.智能压力衣具有使用方便、省时、疗效好等特点,可在临床推广使用.
    목적 초보연구압력치료적작용궤제,탐토유효적압력치료조시.방법 설계다조시험,분별탐토압력치료적료효여작용궤제、지능압력의적연제급응용효과.(1)압력치료적료효연구.장45례사지소상환자안조수궤수자표법분위압력치료조36례화대조조9례,압력치료조매일초과23 h천착량신정주적압력의(압력위10%축솔+국부9 mm후압력점),대조조불진행침대반흔적임하치료.채용온가화반흔량표(VSS)、안색광학측시의화연조직촉진초성계통평정반흔정황,대수거진행독립양본t검험혹배대t검험.(2)료해Fb재압력작용하생장속솔적변화.종수술절취적반흔조직중제취Fb,분별시가1.1、2.8、5.6 mm Hg(1 mm Hg=0.133 kPa)압력급불시가압력,관찰Fb적생장속솔(수거진행Fisher LSD post-hoc분석).(3)압력작용하반흔후도적연구.응용고빈초성성상계통,평고불동시기(조기:1～6개월,중기:7～12개월,후기:대우12개월)증생성반흔조직재0、5、15、25、35 mm Hg압력작용하적후도변화(수거진행상관성급회귀분석).(4)지능압력의적응용연구.촉증경접수과전통압력의치료적36례환자천착지능압력의1개월,응용Pliance X계통진행압력측정병발방문권조사환자사용정황,수거행Wilcoxon Sign-Ranks검험.결과 (1)치료2개월압력치료조반흔후도、안색급VSS평분균교치료전명현개선;여대조조상비,치료2개월압력치료조VSS평분명현강저.(2)가압2 d,시가압력위5.6 mm Hg적Fb생장속솔명현저우미시가압력자(균차=0.086、P=0.001);가압3 d,시가압력위2.8、5.6 mm Hg적Fb생장속솔명현저우미시가압력자(균차분별위0.060、0.118,P치분별위0.003、소우0.001).(3)증생성반흔조직적후도재압력작용하명현변박,차후도여압력대소정부상관(r=-0.96,P＜0.01).(4)사용지능압력의1개월후,정태압력감소19.5%、동태압력감소11.9%,명현저우전통압력의압력감소량(약위50.0%).문권조사결과현시,지능압력의재서괄성、투기성、료효등방면균명현우우전통압력의(P치균소우혹등우0.001).결론 초보증명압력치료능유효억제증생성반흔생장,단기학절궤제잉수진일보연구증실.지능압력의구유사용방편、성시、료효호등특점,가재림상추엄사용.
    Objective To investigate the mechanisms of pressure intervention, and to explore the most effective regime for pressure therapy. Methods Several trials were carried out to study the efficacy and mechanism of pressure therapy, and the development and application efficacy of a smart pressure monitored suit (SPMS) for scar management. ( 1 ) Effectiveness of pressure therapy. Forty-five patients suffered burn on extremities were divided into pressure treatment group ( n = 36) and control group ( n =9) according to the random number table. Patients in pressure treatment group were prescribed with a regime of wearing custom pressure garment ( 10% strain rate of pressure + 9 mm thick local pressure padding) more than 23 hours per day, while no active intervention was conducted on patients in control group. Scar conditions were assessed using the Vancouver Scar Scale (VSS) , spectrocolorimeter, and tissue palpation ultrasound system. Data were processed with t test or paired t test. (2) Changes in fibroblasts growth rate under pressure. Fibroblasts extracted from scar tissue excised during surgery were loaded with 0, 1.1,2.8, 5.6 mm Hg ( 1 mm Hg =0. 133 kPa) pressure respectively to observe the growth rate of fibroblasts. Data were processed with Fisher LSD post-hoc analysis. (3) Scar thickness upon pressure. The changes in scar thickness upon 0, 5, 15, 25, 35 mm H g pressure were measured at early stage (1-6 months) , mid-stage (7-12 months) ,and late stage (more than 12 months) using the high frequency ultrasound imaging system. Data were processed with correlation analysis and regression analysis. (4) Study on application of SPMS. Thirty-six patients with hypertrophic scars once treated with the conventional garment were recruited and they were prescribed with the regime of wearing SPMS for one month. Feedback from all participants in rating conventional garment and SPMS was obtained using self-reported questionnaire. The interface pressure of pressure garment was measured using the Pliance X system. Data were processed with Wilcoxon Sign-Ranks test. Results ( 1 ) Scar thickness, color, and VSS score were significantly improved in pressure treatment group after twomonth of pressure intervention. VSS score of the scars in pressure treatment group was lower than that in control group two months after treatment. (2) The growth rate of scar fibroblasts under 5.6 mm Hg pressure was obviously lower than that under 0 mm Hg pressure 2 days after pressure loading ( mean deviation = 0. 086,P =0. 001 ). Growth rates of fibroblasts under 2.8 and 5.6 mm Hg pressure were obviously lower than that under 0 mm Hg pressure 3 days after pressure loading ( with mean deviation respectively 0. 060 and 0.118,P =0.003, P ＜0.001 ). (3) Scar thickness was significantly reduced upon pressure, and a negative relationship between scar thickness and pressure level was observed ( r = -0.96, P ＜0.01 ). (4) The results of SPMS study showed a reduction in both static pressure ( 19.5% ) and dynamic pressure ( 11.9% ) after one month of usage; while there was nearly 50.0% reduction in pressure in conventional garment. SPMS was rated significantly higher than conventional garment in terms of comfort, permeability and clinical efficacy ( P ≤0. 001 ). Conclusions Pressure therapy can effectively inhibit the growth of hypertrophic scar,while its exact mechanism needs further study for verification. SPMS is convenient to apply for patients. It takes less time to fabricate and adjust when compared to the conventional garment. Its clinical effect is positive and it may expand its application to other medical conditions.
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